| NPI | 1497805519 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: CA 58018) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D11841) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: TX 0023590) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2011-07-01 |